Findings from a study recently published in Eye evaluated the efficacy of tamsulosin on eyelid retraction in patients with thyroid eye disease (TED).
First, what is tamsulosin?
Tamsulosin is an alpha-1 antagonist typically prescribed to patients with enlarged prostate (benign prostatic hyperplasia [BPH]), kidney stones, and prostatitis.
- What it does: Reduces blood pressure by relaxing blood vessels and muscles to allow for improved blood flow and opening of the bladder.
How does this connect back to TED?
Studies have found that eyelid retraction is one of the most common ophthalmic features of autoimmune thyroid disease and can be present in over 90% of TED patients.
Further: Previous studies have suggested that sympathetic overstimulation of Müller’s muscle leads to upper eyelid retraction in TED.
- Meaning: Relaxation of Müller’s muscle via tamsulosin may have a beneficial effect on eyelid retraction.
What about tepezza?
Of note, tepezza (teprotumumab-trbw, Amgen) is the first and currently only FDA-approved treatment for TED that has demonstrated significant improvements in:
- Proptosis
- Clinical activity score (CAS)
- Diplopia
- Quality of life (QoL) in patients with active TED
However: Tepezza’s efficacy in improving eyelid retraction has been variable across studies—highlighting the need for an adjuvant therapy to target upper eyelid symptoms in TED patients.
Now on to this study.
In this single-center prospective study, investigators treated TED patients who had eyelid retraction with oral 0.4 mg/day tamsulosin for 3 months.
In addition, they assessed TED characteristics at baseline and at each subsequent visit, including:
- Upper eyelid margins-to-reflex distance (MRD1)
- Vertical palpebral fissure height (PFH)
- Subjective improvement
- Signs and symptoms of dry eye
- Use of lubricants
Findings?
In total, 11 patients (mean age 47.5 years, 73% female) were enrolled in the study, of which eight (73%) tolerated tamsulosin well and reported no side effects.
- The mean duration of tamsulosin treatment was 84.63 days.
However: Three patients (27%) discontinued the drug due to mild adverse effects that resolved immediately upon stopping treatment, including:
- Dizziness
- Bradycardia
- Nausea
- Gastrointestinal distress
Overall, five patients (45%) experienced an objective improvement in eyelid position and subjective improvement in eye discomfort.
What else?
Both the mean MRD1 and PFH decreased, as shown below:
- Mean MRD1: -1.04 mm (P = 0.015)
- Mean PFH: -1.46 mm (P = 0.039)
Patients discontinued tamsulosin for the following reasons:
- No improvement in MRD1 (n = 3)
- Referral for eyelid surgery with stable inactive TED (n = 2)
- Treatment with intravenous (IV) methylprednisolone due to worsening active TED (n = 2)
- Patient choice after 5 months of treatment with spontaneous resolution of symptoms (n = 1)
Expert opinion?
The investigators concluded that eyelid retraction may threaten vision due to exposure to keratopathy, and its aesthetic alterations may lead to psychosocial implications that affect a patient’s QoL.
A more natural appearance and improvement of exposure keratopathy can be seen in TED patients with just a 1-3 mm reduction in eyelid retraction, which is reflected in the -1.46 mm improvement in palpebral fissure height for this study cohort.
Take home.
These findings suggest that tamsulosin is a safe potential treatment for eyelid retraction in TED patients that could be used as a temporary alternative therapeutic approach for those unsuitable for surgery.
However, further studies with larger sample sizes are warranted to validate these findings.